Vital Info on Medications

The ForwardHealth Portal at www.forwardhealth.wi.gov serving as the interface to the new Medicaid Management Information System for the state of Wisconsin, has implemented the Medication Therapy Management (MTM) benefit in conjunction with the Wisconsin Pharmacy Quality Collaborative. The MTM benefit provides intervention-based services and Comprehensive Medication Review and Assessments (CMR/A).

A CMR/A service may be provided to a member that takes four or more prescription medications to treat or prevent two or more chronic conditions, is diabetic, requires coordination of care due to multiple prescribers, has been discharged from the hospital or long term care setting within two weeks, and has health literacy issues.

If a member has one of the criteria, then the pharmacy must call the Drug Authorization and Policy Override Center to request approval to provide CMR/A services for the initial issue and up to three follow-up CMR/As.

The CMR/A services are voluntary medication reviews for members performed by a pharmacist and may include analytical, consultative, educational, and monitoring to help members get the best results from medications through consumer understanding of medication therapy thereby increasing adherence to medications and at the same time control costs, and prevent drug complications.

This can be accomplished by providing an updated personal medication record and action plan, provide information and resources to help with the therapeutic regimen, document the care delivered, communicate essential information to the member’s primary care providers, and coordinate and integrate medication management services within the broader healthcare system.

The pharmacist performing the CMR/A may meet with the member, consult with the prescriber if needed, document the intervention, and then submit a professional claim for the CMR/A.